Summary The focus of this project is to build research capacity to investigate cognitive impairment (CI) and its risk factors in Kazakhstan (KZ), a high middle-income country in Central Asia that is undergoing rapid epidemiological transition. KZ is expected to experience a high burden of CI and dementia in the near future because (1) the number of elderly aged 60+ is expected to substantially increase; (2) the burden of cardiovascular (CV) risk factors, which are risk factors for CI and dementia, is estimated to be very high in KZ, and (3) the population has been exposed to high levels of air pollution, which is reported to be associated with harmful effects on cognition in the elderly. Despite the anticipated rise in CI and dementia in KZ, reports on prevalence and risk factors are scarce. In addition, despite availability and clinical use of many neuropsychological tests widely used in Western countries, normative values for these neuropsychological tests have not been established. We have recently conducted a population-based study in KZ that revealed a high burden of CV risk factors. Midlife levels of CV risk factors are associated with late-life dementia, typically 20+ years later, yet the association of late-life levels of CV risk factors is weak. We and others recently showed that measures of cumulative burden of CV risk factors, i.e., coronary artery calcification (CAC) and pulse wave velocity (PWV), in late life are associated with CI and dementia. Thus, CAC and PWV can be considered as novel risk factors for CI in late life yet no previous epidemiological study has examined these measures in KZ. A recent paper from KZ showed that the estimates of particulate-matter air pollution are 5 times higher on average than in the US. This analysis, however, did not provide individual risk estimates. To fill these gaps, we aim to establish normative values for neuropsychological tests, build research capacity for assessing CAC and PWV, and explore the individual levels of exposure to air pollution leveraging the existing data in KZ through our collaborative work between the Kazakh National Medical University and the University of Pittsburgh. Of note, the Kazakh National Medical University will participate in a biobank project in 2019, where a population-based sample of 25,000 subjects will be enrolled. Successful completion of this study will develop research infrastructure and expertise in KZ, ideally leading to an R01 to establish a unique cohort from the biobank project to assess prevalence of CI and risk factors in KZ (i.e., CAC, PWV, air pollution) standardized to the methods used in epidemiological studies in the US.